OT: Paying for pregnancy and birth

[WDWorBUST]

My experience is with the Indian Hospital in Claremore. My friends who have had babies there were fine with the care. Overall - and this is my opinion - all doctors go through the same schooling and testing. Now I know there will still be good and bad as with everything, but they should all be competent.

Now personally.....I was pregnant earlier this year (I had a miscarriage) and was seriously considering using the Indian hospital since it is free. However, after really debating it I decided it wasn't the best option for me. 1.) I have insurance through work 2.) I wanted to see the same doctor throughout my pregnancy who was familiar with me 3.) Regardless of if you have an appt you'll waste at least half a day for a 30 minute visit.

Now if it came down to out of pocket or using the Indian hospital you can bet I would use the indian hospital.

 

[alyssa810]

Just wondering what an "Indian Hospital" is?

I'm fortunate to have really good insurance through work; I had a c-section (not planned or emergency, DS was a failure to progress) and then my incision got infected after I got home. I had to have visiting nurses come daily for almost 3 months. I didn't have to pay anything out of pocket for that (thank goodness as it was $157 a day!!) - it was all covered. My hospital bill for the delivery was around $7500, and I had a $150 co-pay. I only had to pay my OB for my first pre-natal visit, and then I did have to pay for my post-surgery visits which were $20 a pop (which when I got the itemized bills for around $400 pop, $20 didn't seem so bad). Every day I'm grateful for my insurance as my DS wouldn't have been affordable without it! I too would recommend having a plan in place before TTC...

 

[SageFemme]

I just want to emphasize, again, that me and the baby WILL be covered regardless if we chose the Indian hospital or BCBS.

Catananche: You are correct on the meaning! I have no idea how to pronounce it correctly, but I still like it!

alyssa810: An Indian hospital is what those who have a Certificate of Degree of Indian Blood card can go to. Interestingly, the first midwifery practice in OK was an Indian health care facility

 

[littlbugmom]

I actually think 400.00 a month is GREAT LOL Our is 600.00 a month for a family plan.

Wow! Ours is less than $180 a month for family coverage and it's good coverage. I thought that was normal??? I guess I can't complain.

 

[WDWorBUST]

I just want to emphasize, again, that me and the baby WILL be covered regardless if we chose the Indian hospital or BCBS.

Just an fyi.....a lot of insurance carriers will not consider Indian Health Coverage as continuous coverage when it comes to pre-existing conditions. And I am almost positive that BCBS does NOT....so if you use the Indian Hospital and the baby does have problems BCBS might pre-ex him/her when writing your policy. (I checked on this very thing when I was considering it - I also work in Benefits) Just something you will want to keep in mind.

 

[SageFemme]

Just an fyi.....a lot of insurance carriers will not consider Indian Health Coverage as continuous coverage when it comes to pre-existing conditions. And I am almost positive that BCBS does NOT....so if you use the Indian Hospital and the baby does have problems BCBS might pre-ex him/her when writing your policy. (I checked on this very thing when I was considering it - I also work in Benefits) Just something you will want to keep in mind.

Thanks for the info!! That certainly makes me more sure we will use BCBS from the beginning. Now, what if I have BCBS while I'm pregnant and the baby is born with health issues? Will they still cover it? I have heard it is covered for the first 30 days and you can put it on your plan within those first 30 days...but what if it has health issues?

 

[WDWorBUST]

As long as you are covered by BCBS when the baby is born there shouldn't be a problem. The baby being born is a qualifying event to "add" him/her to your coverage. If you don't actually apply for coverage until after the baby is born then they will be looking at you all in terms of health, etc as far as any pre-existing exclusions. Does that make sense? Even if you don't have maternity care coverage under your BCBS policy you "should" still be able to add the baby at birth without concern, but I would confirm that with a BCBS rep just to be sure.

 

[WDWorBUST]

Oh....and definitely run it all past a BCBS rep. I am not as familiar with "private" policies vs. group policies so I wouldn't want to steer you wrong by mistake (a lot of it is the same, but some things are different depending on if it's a group or private plan.)

 

[Piecey]

I don't know that I'd wait to try to pay OOP...

I don't have all my bills yet, but so far I'm at...

$10k- Hospital Room and Board/Supplies/OR fees
$4k - Obstetrician fee for c-section
$9k - Obstetrician fee for prenatal care
$4k - Baby's hospital stay
$3k - my anesthesia/anestheseologist fee

They're all still coming to... those are just the ones I've received so far.

Luckily, I have 2 insurance policies and 1 covers maternity/delivery at 100%... I certainly don't think we could have done it otherwise.

 

[SageFemme]

Okay, so we figured out what we're going to do for the 365 day waiting period. We're going to wait till our house is finished building, then I will get "basic" insurance for just me with maternity at $153/month with a $5,000 deductible. I don't go to the doctor but once a year anyway. After the year is up, we will do a different policy with or without DH (not sure). Our house will be finished around Feb. 2010 so that would mean we would start TTC in Feb. 2011 - a long time from now but I guess I will plan our Dec. 2010 trip in the mean time!

Okay, forgive me but I have another personal WWYD question. I know that this depends on personal finances but after this year's plan is up, would you get a $5,000 deductible if after that everything is paid at 100%? This would be the plan we use for pregnancy/birth. Prices are subject to change, of course, but here's what they are now. We are new to insurance so not sure what would be the best option. I guess it would be smart to find out approximately how much my prenatal vists and birth would cost. These all include maternity coverage. The options are:

Plan A:

$1500 Deductible.
$15 copay for office visits.
After deductible, 70% for rx.
All outpatient and inpatient services (incl. maternity) are paid at 80%, meaning we would have to pay 20%.
Prices per month, incl. maternity:
Me only: $326
Me, then after baby is born: $395
Me, DH: $441
Me, DH, then after baby is born: $510

Plan B:

$5,000 Deductible for Family and $2500 for just me.
After ded. is met, everything is paid at 100%.
Prices per month, incl. maternity:
Me only ($2500 ded.): $250
Me, then after baby is born: $285
Me, DH: $318
Me, DH, then after baby is born: $368



Yep, that pretty much sums up how I'm feeling right now!

I guess this would fit better in the Budget forum, huh? I will ask this specific question there as well.


Am I right that the best deal would depend on how much prenatal care/birth would cost?

 

[MarriedToAPrince]

Honestly I would wait and get insurance. I would want a dr who has a good bedside manner and who will listen to me especially when the pregnancy hormones are raging. Also you never know how expensive your maternity and delivery charges will be. I ended up with a c-section and a 5 day hospital stay and my maternity and delivery charges were well over $20K. I would never want to pay that out of pocket.

 

[hopeis]

Wow! I had no idea that having a baby was such an expense! I have to say thankfully that is all covered by our provincial health plan here in Canada! Luckily for me, I had high risk pregnancies (after finally getting pregnant and seeing an excellent fertility specialist) and had 7 ultrasounds with one of my kids.

All the best to you all!!

 

[jboysen]

Thanks for your reply. I believe we have decided to go ahead and get the insurance. As far as waiting, it is a difference of Spring 2010 and Spring 2011. But if that's what we gotta do, it's what we gotta do.

I do have a question about networks. We will meet with an agent next week but until then, I wanted to ask. They have different "networks" that pay 60%, 70%, and 80%. From my understanding, you pick a doctor that has the network that pays whatever percetage you want, correct? Or do you have to choose one network for everything? Does this change your premium cost?

Not sure on the premium cost, because we go through DH's employer, we have the 80% coverage. If we go out of network, we have to pay more oop. I think it also depends on what you want your dedutible to be. There is a specific line to ask your health facility not just if they accept it, they all will accept insurance, it is just a matter as if they are in your network. The person you are meeting with can tell you that. If you know what facillity you are looking at they should know if they are in the network. We live in a small town, and get our insurance though DH's employer, so our medical center qualifies for the in network, but with my complicated pregnancy I was at Mayo clinic 45 minutes away and had no more oop costs than my deductable and copays. Also whenever I've had questions and call ed, all the coustomer service reps have been very helpful over the phone. Hope this helps!

 

[NotUrsula]

A lot depends on your health. How old are you? Do you smoke or drink more than maybe a beer once a week or so? Are you overweight? How's your blood pressure? Are there any diabetics anywhere in your family? Have you had issues with your periods being a bit wonky? Talk to your mom. It's not gospel, but the pregnancy histories of your mother, maternal aunts and older sisters (if you have any) COULD show you things that you may need to be thinking about. (With my first child my OB was VERY concerned that I might develop pre-eclampsia b/c my sister did; as it turned out I was fine.) If your DH has any inherited health conditions in his family tree, you should be aware of those for the issue of how much it might cost to treat the baby.

If you're healthy and don't have any family red flags, I'd say go with the low-deductible policy, which will pay better for your ongoing care and checkups. If there is any indication that you could be at risk for a pricey complication I'd go with the high-deductible plan, because 20% of a high-risk pregnancy and delivery will probably exceed $5K in nothing flat. I was considered high-risk because of my age when DD was born two years ago, and even though my delivery went very easily, all of the extra monitoring and such that the hospital insisted on cost a mint. DD had a bit of a breathing problem at birth; the tests to find out that it was transient and nothing serious cost $7K.

Just FYI, $368/mo is NOT very expensive for an independent plan. I paid $100 more than that for family group coverage at my last job (I left 4 years ago). Right now we have REALLY great coverage, and I get it at what I consider an AMAZING bargain price: $177/mo. (My employer contributes about $1400/mo to pay for it.)

Are you both self-employed? Are there any kind of professional association health plans that you could buy into? (My sister is a self-employed photographer, she gets her group coverage through her membership in the Professional Photographers of America.)

If you're not self-employed but you don't get health insurance benefits, use the FSA plan (if there is one) to shelter your premiums pre-tax. If there isn't an FSA, push HARD for one. They don't cost very much to administer, but they make it a lot easier for employees to manage the premiums for private insurance if an employer cannot afford to offer a group plan.

Oh, and for our Canadian poster, in most US states even really good insurance plans don't cover fertility treatments. (A few states require by law that they cover, but most don't.) A friend of mine who worked at the same company started out $46K in debt when she finally got pregnant with twins. They weren't poor by any means, but all of us dug deep for gifts to get thier nursery goods taken care of so that they could put their own money toward retiring that medical debt. The medical cost issues are a big part of family planning decisions for most Americans.

 

[SageFemme]

Well we ended up going to the main office today to talk to an agent and walked out with insurance, LOL. That seems to always be how it ends up, huh? LOL

Of course we haven't "officially" been approved yet...but we got the "Basic" plan for both of us. It's an 80/20 plan with maternity coverage and dental. $275/month. We got the highest deductible ($5000) for this first year for the 365 day maternity waiting period and will choose another plan for the year after this one.

I'm still needing to decide if we are going to use Plan A or Plan B for the next coverage year starting Sept. 2010 so please keep the comments coming!

Thanks!! I'm getting a lot of great ideas from y'all!

 

[WDWorBUST]

Just remember.....insurance premiums typically increase each year. I would almost say to plan on a 20% increase to be prepared and hopefully it's more in line with the 10% give or take norm.